An Anthropological Investigation of Lay
and Professional Meanings of Quality of Life
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Background

Quality of Life (QoL) assessment is regarded as appropriate in the evaluation of treatment outcomes, the organisation of health care services and in the monitoring and audit of services. Using psychometrically valid, standardised questionnaires, researchers assume that they are incorporating patients' and users' perspectives in evaluations. Although there has been an enormous growth in (QoL) research, there appears to be no consistent view about how it should be defined or measured. Many researchers, however, agree that it must incorporate non-clinical aspects of health such as patients' social activities, relationships and expectations.

Aims and Objectives

The aim of this study is to examine the multiple meanings of the concept of (QoL) for older stroke patients and the ways in which this concept influences the delivery of health care for them. The study will use stroke as a case study since it has symbolic and pidemiological associations with ageing, and is a leading cause of disability among older people.

The objectives of the study are to examine:

	The perceptions of health professionals about the constituents and meanings of (QoL) for older stroke patients, both as a quantifiable outcome and as a tacit value.
	The means by which professionals' views of (QoL) influence decision making, practice and policy making with regards to stroke patients.
	The views of stroke survivors about the constituents and meanings of (QoL), comparing them to professionals' concepts.

Study Design

Open-ended interviews with professionals will be conducted with a purposive sample of clinical staff working with older patients in three hospital settings. Clinical staff includes junior and senior doctors, physiotherapists, psychologists and occupational therapists. A two-stage interview process will explore older people's perceptions of (QoL) after stroke. Initial interviews with 50 stroke patients will be conducted prior to discharge from hospital. A second round of interviews will take place with the patients, six months after discharge to obtain data on longer-term issues.

Ethnographic work will be conducted on wards and in multidisciplinary team meetings to observe the ways in which ideas about (QoL) affect decision making processes in acute settings. A national postal survey of professionals delivering care for older people and stroke care will also be conducted to explore their views and current use of standardised instruments to evaluate care services and guide clinical decision making. The national survey will allow us to situate local findings in the hospitals within the national context.

Policy Implications The study will clarify what (QoL) is for health care professionals and how their definitions compare to the ideas of older people and themselves. It will examine how (QoL) assessment and tacit values influence health care delivery, individual care and policy development. It will also identify strategies to promote the inclusion of lay priorities in definitions and assessments of (QoL).